On-Prem PIMS Still Run Nearly Half the Market: What That Means for Choosing the Best Veterinary AI Scribe

Summary: In an informal poll of practice teams at this year's AVMA conference, HappyDoc found that nearly half of veterinary clinics are still running one of three legacy, on-premise PIMS: AVImark, Cornerstone, or ImproMed. Independent industry research backs up that finding almost exactly. That matters more than it might seem, because on-premise PIMS are structurally harder for any AI scribe to integrate with, and most AI scribes still cannot write structured SOAP notes directly back into them. This guide walks through what the data shows, why on-prem integration is a different problem than cloud integration, and why that gap is exactly what separates a merely "PIMS-compatible" tool from the best veterinary AI scribe for practices on a legacy system.

What We Found: Nearly Half of Practices Are Still on Legacy, On-Prem Systems

We asked AVMA conference attendees a simple question: what PIMS does your clinic run on? The answer split roughly like this:

• AVImark: 23%
• Cornerstone: 15%
• ImproMed: 8%

That's 46%, nearly half of every clinic we talked to, running on one of three legacy, on-premise systems. The other half is spread across a wide array of cloud-based platforms, including ezyVet, Vetspire, Shepherd, DaySmart, and Digitail.

Our informal poll lines up closely with the largest independent research on this question. The Companion Animal Veterinary Software Guide (CAVSG), a research series published by Jonathan Ayers and Adam Wysocki at VetSoftwareHub, fielded a Kynetec-run survey of 1,273 North American practices and found that AVImark holds 25.4% of practice-count-weighted market share, Cornerstone holds 19.5%, and ImproMed holds 5.8%. Those same three legacy, on-premise systems again account for roughly half the market. Across the full PIMS landscape, on-premise systems represent 56.9% of practices, with cloud platforms making up the remaining 43.1% (CAVSG Part VIII: The PIMS Share Report).

Two different survey methods, pointing at the same reality: on-prem PIMS isn't a shrinking legacy footnote. It's still close to half the market, and for that huge a share of practices, it's the system any AI scribe has to actually work with, not just claim to support.

Why On-Prem PIMS Is a Different Integration Problem Than Cloud

Not all PIMS integration is created equal, and the difference comes down to architecture, not brand.

Cloud PIMS platforms like ezyVet, Vetspire, and Shepherd run through a vendor-controlled API gateway. The PIMS vendor decides who gets access, on what terms, and often at what price, but a documented, sanctioned path to that data generally exists.

On-premise systems like AVImark, Cornerstone, and ImproMed work differently. Because the software runs on a server inside the clinic rather than in the cloud, there is typically no vendor-published API for an AI scribe to connect to at all. Instead, third-party tools connect through middleware: local software agents such as BitWerx, Covetrus Connect, or AllyDVM that sit on the practice's own server and relay data back and forth. Independent software vendors surveyed by CAVSG describe this path as workable, but often imperfect: sync frequencies can be slow, feature coverage is limited, and commercial terms are frequently negotiated under non-disclosure agreements rather than published openly (CAVSG Part IX: In Their Own Words).

That distinction matters enormously for AI scribes specifically, because a scribe's entire value proposition rests on getting a complete, accurate SOAP note into the medical record with no manual re-entry. CAVSG's research includes a striking detail directly on this point: for Cornerstone, ISVs report there is no direct API, so integration only happens through middleware, and write-back through that middleware is often limited to dropping text into a generic notes field rather than populating the structured history, exam, assessment, and plan sections a true SOAP note requires. An AI scribe that can only "write back" a wall of unstructured text into a catch-all field isn't delivering the same value as one that can populate discrete, structured fields.

What Practices Actually Want: Bidirectional Write-Back, Not Just Read Access

The demand side of this story isn't ambiguous. CAVSG's practice-level research found that 80% of practices rate read access into their PIMS as important, and 75% rate write-back specifically as important, with nearly all of those respondents volunteering an open-ended explanation of why (CAVSG Part VI: Eighty Percent and Rising). A later installment of the same series found that 88% of PIMS-using practices rated read and/or write-back access by third-party applications as important to their operations overall.

The supply side agrees, at least in principle. Every single independent software vendor surveyed by CAVSG, 100% of them, said that read or write-back access, or both, is important to delivering full value to their practice customers. Every one of them also said they would prefer a PIMS-sanctioned integration path over an unofficial workaround, and where ISVs have used alternative methods, it was because no sanctioned path was actually available to them.

In other words: practices want two-way integration, AI scribe vendors want to build it the right way, and the on-premise PIMS layer is where that intention most often runs into a wall.

The Integration Openness Gap, By the Numbers

CAVSG's ISV survey asked independent software vendors to rate the API openness of each PIMS they had worked with, on a 1-to-5 scale. Weighted by each PIMS's share of practices, the average openness rating across fourteen platforms was 2.23 out of 5. When the same vendors were asked to rate the overall veterinary PIMS ecosystem as a whole, the average dropped to 1.95, with most individual responses landing on "mostly closed."

The gap is not evenly distributed. PIMS owned by the two largest vendor families, IDEXX and Covetrus, together representing an estimated 79% of North American practices, carry a weighted openness rating of just 2.02. Independent PIMS, as a group, rated 3.28. Every single aggregator-owned PIMS in the survey, including AVImark, Cornerstone, and ImproMed, rated below every independent PIMS in the study.

There's a cost dimension to this too. ISVs reported middleware access fees in the range of $30 to $85 per clinic per month, on top of setup costs that in some cases ran into the thousands of dollars, layered on top of whatever the AI scribe itself charges the practice.

The three legacy, on-premise PIMS at the center of our AVMA poll are the same three that show up on the most restrictive end of that scale. That's not a coincidence of branding. It's a direct result of how on-premise systems are architected, and who has historically had to build the bridge to get third-party data flowing at all.

What This Means for Choosing the Best Veterinary AI Scribe

If your clinic runs on AVImark, Cornerstone, or ImproMed, "integrates with your PIMS" isn't a specific enough claim to evaluate an AI scribe on. Before you sign anything, it's worth asking the same kind of direct questions CAVSG recommends practices ask their PIMS vendor, adapted for an AI scribe evaluation:

• Does this scribe write structured SOAP notes into discrete fields in my PIMS, or does it drop a block of text into a generic notes area?
• Is the integration native, or does it rely on third-party middleware? If middleware, which one, and is there an added monthly fee?
• Can I see this working live, on a demo of my actual PIMS, not just hear that it's "supported"?
• What happens to that integration if my practice ever migrates from an on-premise system to a cloud PIMS?

The best veterinary AI scribe for a clinic on a legacy, on-premise system is one built for that architecture specifically, rather than one that treats it as an afterthought. That's a meaningfully different engineering commitment than supporting a cloud PIMS with an open, documented API, and the data above is a good explanation for why so few vendors have made it. For a broader look at how to evaluate scribes beyond PIMS integration alone, see HappyDoc's guide to the best veterinary AI scribe.

HappyDoc built its integration with AVImark and Cornerstone specifically, rather than routing around the problem with generic middleware, and supports two-way read and write workflows with those systems as well as ImproMed, Vetspire, Shepherd, ezyVet, DaySmart, and Pulse (see HappyDoc's PIMS integrations). For practices on a PIMS not natively supported, a browser-based option is available as a fallback, so no clinic is stuck re-typing notes by hand.

Looking Ahead

One long-time veterinary software developer interviewed for the CAVSG series raised an interesting possibility: as computer-use AI tools advance, it may eventually become much harder for any PIMS, cloud or on-premise, to effectively wall off practice data from the tools a clinic has chosen and consented to use. If that plays out, the on-premise integration gap described above could start closing from an unexpected direction. For now, though, it remains one of the most important, and most overlooked, questions a practice can ask when choosing an AI scribe.

Frequently Asked Questions

Q: What's the difference between an on-premise PIMS and a cloud PIMS? An on-premise PIMS like AVImark, Cornerstone, or ImproMed runs on a server physically located inside the clinic. A cloud PIMS like ezyVet, Vetspire, or Shepherd runs entirely in the browser, with the vendor hosting the data and controlling access to it.

Q: Why can't most AI scribes write structured SOAP notes into on-prem PIMS? Most on-premise systems have no vendor-published API for third-party software to connect to. Integration instead happens through middleware that sits on the clinic's server, and that middleware's write-back capability is often limited to a generic notes field rather than the structured history, exam, assessment, and plan sections a true SOAP note requires.

Q: Is bidirectional (two-way) integration actually necessary for an AI scribe? For most practices, yes. Reading patient history in makes a scribe's notes more accurate and contextual. Writing structured notes back out is what eliminates manual copy-and-paste, which is the time savings most practices are looking for in the first place.

Q: Does HappyDoc work with on-premise systems like AVImark and Cornerstone? Yes. HappyDoc built dedicated, two-way integrations for AVImark and Cornerstone specifically, and also connects with ImproMed, Vetspire, Shepherd, ezyVet, DaySmart, and Pulse.

Q: What is the most popular veterinary PIMS in North America? According to HappyDoc's survey, Covetrus AVImark is the most widely used with approximately 23% market share.

Curious how HappyDoc's integration works with your specific PIMS? Book a demo and we'll walk you through exactly how read and write-back works for your system, on-premise or cloud.

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